Obstructive Sleep Apnea Syndrome: A Review of 306 Consecutively Treated Surgical Patients
- 1 February 1993
- journal article
- review article
- Published by Wiley in Otolaryngology -- Head and Neck Surgery
- Vol. 108 (2), 117-125
- https://doi.org/10.1177/019459989310800203
Abstract
Three hundred six consecutively treated surgical patients with obstructive sleep apnea syndrome were evaluated from a group of 415 patients. One hundred nine patients were excluded because they failed to obtain a postoperative polysomnogram or were lost to followup. All patients received a physical examination, cephalometric analysis, fiberoptic examination, and polysomnography before treatment to document OSAS and determine the areas of obstruction. A two-phase surgical protocol was used for the reconstruction of the upper airway. Phase I surgery consisted of a uvulopalatopharyngoplasty (UPPP) for palatal obstruction and genioglossus advancement with hyoid myotomy-suspension for base of tongue obstruction. Failures of phase I were offered phase 2 reconstruction, which consisted of maxillary-mandibular advancement osteotomy. One hundred twenty-one patients were treated with nasal continuous positive airway pressure (CPAP) before surgery and this was the primary method of evaluating surgical success. Results were reported on the polysomnogram performed a minimum of 6 months after surgery and compared to the preoperative polysomnogram and the second night nasal CPAP study. The polysomnographic results included respiratory disturbance index (RDI), lowest oxyhemoglobin saturation (LSAT), and sleep architecture parameters. Surgery was considered a success if it was equivalent to nasal CPAP or the postoperative RDI was less than 20 with normal oxygenation. The overall success rate, which included patients that dropped from the protocol, was 76.5%, with a mean followup of 9.3 months (SD, 6.7). The preoperative RDI, nasal CPAP RDI, and postoperative RDI were 55.8 (SD, 26.7), 7.2 (SD, 5.4), and 9.2 (SD, 7.5), respectively. The preoperative LSAT, nasal CPAP LSAT, and postoperative LSAT were 70.5 (SD, 15.8), 86.7 (SD, 8.5), and 86.6 (SD, 4.1), respectively. Patients who proceeded to completion of the protocol had a success rate of more than 95%. This report has allowed us to conclude that a comprehensive presurgical evaluation allows a logical approach to reconstruction of the upper airway, and patients who complete the surgical protocol have a greater than 95% long-term success rate, which is superior to any other treatment modality.Keywords
This publication has 20 references indexed in Scilit:
- The Effect of Nightly Nasal CPAP Treatment on Underlying Obstructive Sleep Apnea and Pharyngeal SizeChest, 1991
- Long-term Compliance with Nasal Continuous Positive Airway Pressure Therapy of Obstructive Sleep ApneaChest, 1990
- Long-term Outcome for Obstructive Sleep Apnea Syndrome PatientsChest, 1988
- Current surgical concepts for treating obstructive sleep apnea syndromeJournal of Oral and Maxillofacial Surgery, 1987
- Predictive value of müuller maneuver in selection of patients for uvulopalatopharyngoplastyThe Laryngoscope, 1985
- UvulopalatopharyngoplastyChest, 1985
- Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndromeThe American Journal of Cardiology, 1983
- Reversal of the Pickwickian Syndrome by Long-Term Use of Nocturnal Nasal-Airway PressureNew England Journal of Medicine, 1982
- REVERSAL OF OBSTRUCTIVE SLEEP APNOEA BY CONTINUOUS POSITIVE AIRWAY PRESSURE APPLIED THROUGH THE NARESThe Lancet, 1981